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Do Patients With Non-Viable Myocardium From Ischemic Cardiomyopathy Benefit From Revascularization? A Systematic
Farideh Davoudi1, Satoshi Miyashita2, Tae Kyung Yoo3
1Department of Medicine, Mass General Brigham-Salem Hospital, MA, USA.
Summary
Revascularization benefits patients with ischemic cardiomyopathy and non-viable myocardium, reducing all-cause mortality compared to medical therapy alone. This finding challenges the necessity of myocardial viability for treatment selection.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Myocardial viability assessment guides revascularization decisions.
- Controversy exists regarding revascularization benefits in ischemic cardiomyopathy without viable myocardium.
Approach:
- Meta-analysis of 12 studies up to December 2021.
- Compared revascularization versus medical therapy in patients with non-viable myocardium.
- All-cause mortality was the primary outcome measure.
Key Points:
- 1363 patients with non-viable myocardium included (501 revascularization, 862 medical therapy).
- Revascularization significantly reduced all-cause mortality (RR 0.76, 95% CI: 0.62-0.93).
- No association found between viability imaging modality and mortality risk.
Conclusions:
- Revascularization offers a survival benefit in ischemic cardiomyopathy patients even without viable myocardium.
- This meta-analysis suggests revascularization is beneficial regardless of myocardial viability.
- Treatment decisions may not solely depend on demonstrating myocardial viability.
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